MEDICARE: DR. CRAIG A GERKEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4 5224	OK

General Provider Information

NPI Number	:	1063585073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A GERKEN DDS

Provider Business Mailing Address
First Line	:	1201 KIOWA STREET
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2246
Country	:	US
Telephone Number	:	580-226-8868
Fax Number	:	580-226-4926

Provider Business Practice Location Address
First Line	:	1201 KIOWA STREET
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2246
Country	:	US
Telephone Number	:	580-226-8868
Fax Number	:	580-226-4926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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